01.09.2014 That last "one for the road" can be one too much in the elderly

Alcoholism in ageing. Every sixteenth person in Switzerland over the age of 60 regularly drinks too much alcohol. This problem is often not taken seriously.

Pictures That last "one for the road" can be one too much in the elderly

TODO CHRISTIAN

The large majority of the elderly in Switzerland confine their alcohol intake to a low-risk occasional glass of red wine or beer. However, 6.4% of this age group exhibit "chronic high-risk alcohol consumption", with about twice as many men being affected as women. "Chronic high-risk" means an average daily intake of more than four (men) and more than two (women) standard alcoholic drinks a day. A standard drink is, for instance, 300 ml of beer or 100 ml of wine.

Stronger effect in the elderly
These limit values of four and two glasses of alcohol a day are undoubtedly harmful to health in all people. But even smaller quantities can be problematic, particularly in the elderly, who are at increased risk of addiction. It is estimated that one elderly alcoholic patient in three only develops their alcohol addiction after retirement. The reasons are partly physiological: the older the body, the less water it contains and the less any alcohol consumed is diluted. The same quantity of alcohol creates a higher alcohol content per millilitre of blood in the elderly than in a young person. This means that what used to be a safe level of alcohol consumption can turn into a problem in old age. Moreover, the efficiency of the liver declines in old age. It takes longer to break down alcohol, which consequently stays longer in the body.

Retirement – a critical life phase
But there are also psychological and social reasons for the increased risk of addiction in the elderly. For some, retirement is a time of indulgence: the pressures of working life are gone, they have more leisure time, more extra treats in everyday life – an aperitif before dinner, a glass of wine with their meal and a drop of spirits afterwards. For others, retirement is a time of emptiness and loneliness: the end of their working lives also means the loss of their daily routine, bearings and social life. In addition, the loss of people close to them – their life partner, siblings, friends – becomes an increasingly familiar experience in this phase of their lives. In all these cases, alcohol has its attractions and its perils. The occasional drink can grow into two, three or four – and it can become more than occasional.

No trivial matter
Alcoholism in the elderly is usually a silent addiction. Most of those directly affected do not want to admit it to themselves – they are ashamed or they consider the idea absurd that they themselves are addicted. People close to them often play down their alcohol problem and are unwilling to deny their old friend "one (or two or three more) for the road". This approach does not do them any favours: alcohol dependence impairs quality of life in old age just as much as it does in younger people, quite apart from the increased risk of diseases such as diabetes, dementia or cancer that long-term, excessive alcohol intake causes in the elderly. Moreover, alcohol consumption not only has negative effects on health, it also increases the frequency of accidents in the home, during leisure activities and in road traffic.

Discussing changes in behaviour
But how do we recognise alcohol addiction in an elderly person? Besides an increase in accidents, the symptoms of alcohol addiction include apathy, withdrawal, belligerence, restlessness and even weight loss. All these symptoms resemble those of the common illnesses of old age and are therefore usually misinterpreted – even doctors often overlook the possibility of addiction.
For this reason, relatives and friends in particular have an important part to play in identifying problems with alcohol at an early stage. If there is suspicion of addiction in an elderly person, experts recommend tactfully raising the subject of their alcohol intake and the changes observed in their behaviour with them. Questions tend to be more productive than accusations, preaching or arguments. Specialist units also offer relatives assistance and advice on how to deal with alcohol-dependent senior citizens.

Interaction with medicines
Alcohol-related illnesses in advanced age are often aggravated by the medicines that elderly patients typically need to take, for instance antidepressants, sleep-inducing agents, tranquillisers and analgesics. The effects of many of these medicines are strengthened by the presence of alcohol in the blood. Others, in contrast, are broken down more rapidly by alcohol and therefore lose some of their desired effect, which means that the dosage has to be constantly raised. This, in turn, increases the risk of addiction to prescription drugs – a risk that is already relatively high in the elderly.

Good prospects of cure
Alcohol addiction is particularly worthwhile combating in old age. Experience shows that measures taken in the elderly have a very good chance of success. This is particularly true if their alcohol problem has developed late in life. Abstinence can, but does not have to be, a goal of treatment. And there is often no need for long drawn-out therapies – just a few discussions aimed at bringing the cause of the drinking to light may suffice.

Structure, friends, hobbies
There is, however, this to bear in mind: growing old does not mean a life of self-denial. But to ensure that alcohol consumption is kept at a moderate level, it is important in old age to give everyday life a purposeful structure. A good social network, family and hobbies constitute the most effective way to prevent alcoholism in the elderly. A glass of wine or a small beer can then continue to be a well-earned indulgence

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Contact

Contact: David Hess-Klein,
Alcohol Section,
david.hess-klein@bag.admin.ch

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